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100 Cards in this Set
- Front
- Back
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components of CNS
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Brain
spinal cord |
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T/F
Ischemia is caused by an blockage of the venous system |
F
arterial syst blockage |
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list causes of hypoxia
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anemia
respiratory disorders s/a asthma |
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how much of O2 consumption does the brain consume
a) 10% b) 20% c) 50% d) 70% |
20%
1/6 CO |
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what is the primary source of ATP for the brain
a) protein b) glucose c) fat d) none |
glucose
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describe the mechanism of cellular destruction due to lack of O2
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lack O2
no ATP dysfunction of Na/K pump Na/H20 influx K/Ca efflux cellular destruction -> hypoxia/ischemia |
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____ are the most sensitive to the lack of 02
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purkinje fibers- control mvt
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Excitatory AA
a) GABA b) Glutamate c) Acetylcholine d) none |
glutatmate
(GABA, ACh= NTs) |
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pathologic condtion
a) intracellular glutamate > extracellular b) extracellular glutamate > intracellular c) extracellular Na > intracellular d) intracellular K > extracellular |
extracellular glatamate > intracellular
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Which ion channel (s) are controlled by glutamate
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Na, Ca
-> prolonged AP -> swollen neurons/astrocytes |
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dead cells release _____ into the extracellular environ
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glutamate
(cell death due to ischemia depletes ATP -> glutamate accumulation) |
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Which of the following will have the least effect on the ICP?
a) blood volume b) brain volume c) CSF volume d) all affect the ICP |
ALL
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list non pathological cause of an Increased ICP
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sneeze
cough straining |
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cerebral perfusion pressure equals
a) MBP + ICP b) Diastolic - Systolic + ICP c) MBP - ICP d) 1/3 Systole - ICP |
MBP-ICP
pressure of blood flowing to the brain |
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late indicator of ICP
a) widening pulse pressure b) slow HR c) hi BP d) all |
All = Cushing reflex
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Cushing reflex includes all of the following except:
a) Hi BP b) Hi HR c) Widening PP d) all are part of Cushing Reflex |
SLOW HR (but contracting harder/hiBP)
cushing reflex = late indicator of increased ICP |
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____ produces CSF
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Choroid Plexus
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____ reabsorbs CSF
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Arachnoid Granulations
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where does CSF flow in the brain
a) Arachnoid Matter b) Subarachnoid Space c) Pia Matter d) Arachnoid Granulations |
Subarachnoid Space
CSF- stored sugar for the brain, acts as shock absorber |
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list structures that regulate CSF vol
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choroid plexus (prdctn)
arachnoid granulations (absrptn) |
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_____ supplies blood to the braint
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circle of willis
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which is not part of the circle of willis?
a) Basal artery b) Internal Carotid A c) Internal Jugular V d) All |
jugular
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List the components that make up the circle of willis
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Basal A.
->post cerebral A (occipital) Internal Carotid A ->Ant cerebral A (frontal) ->Mid Cerebral A (temporal) |
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stores CSF
a) arachnoid granulations b) subarachnoid space c) ventricles d) all |
ventricles
(lateral (2), 3rd, 4th) arachnoid granulations- reabsorb csf |
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Protects brain from foreign material
a) blood-brain barrier b) meninges c) Interventricular Foreamen d) none |
blood brain barrier
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causes of brain herniation
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brain tumor
puncture in preexisting ICP |
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result of brain herniation
a) edema b) ischemia c) increase ICP d) cardiac arrest |
ALL due to
compression of vascular syst->edema, ischemia impaired CSF flow-> increase ICP, compression impaired medullary function (breathe, HR) impaired cortical/cerebral function |
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T/F
vasogenic edema is related to obstruction of CSF flow |
F
interstitial edema due to obstruction of CSF flow -> white matter edema vasogenic = disruption of BBBarrier-> increase permeability-> white matter edema |
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what causes edema of the brain and where does it manifest
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increased tissue vol due to abnormal fluid accum
edema occurs in white matter |
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T/F
Hypoxia may cause edema of white matter |
F
cytotoxic edema = interruption of Na/K pumps due to hypoxia/acidosis ->edema of neurons obstruction of CSF flow -> edema |
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list complications of brain edema
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compression
herniation cell death |
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abnormal increase of CSF vol in any part of the ventricular syst
a) hydrocephalus b) edema c) encephalitis d) Meningitis |
Hyrodcephalus
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list complications of brain edema
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compression
herniation cell death |
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abnormal increase of CSF vol in any part of the ventricular syst
a) hydrocephalus b) edema c) encephalitis d) Meningitis |
Hyrodcephalus
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list causes of hydrocephalus
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over production CSF
under absorption CSF obstruction CSF |
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non communicating hydrocephalus is caused by
a) overproduction of CSF b) decreased reabsorption of CSF c) Obstruction |
obstruction
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communicating hydrocephalus is caused by
a) overproduction of CSF b) decreased reabsorption of CSF c) Obstruction |
impaired reabsorption
adenoma of choroid plexus-> over production obstruction = non-communicating |
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list pathologic changes of hydrocephalus
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-dilation of ventricles
-cerebral compression -> reduce vol of white matter -Increase ICP (hydrocephalus= abnormal increase in CSF vol in ventricular syst) |
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a person that is brain dead will have all of the following except
a) constricted pupils b) neg corneal reflex c) neg doll eye reflex d) all will occur |
DILATED and non reactive pupils
also: neg pupillary rxn to light neg gag reflex neg oculovestibular reflex neg apnea test flat EEG for >30s |
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true statement about persistent vegetative state
a) brain stem functions intact b) sustained behavioral responses c) language comprehension d) spinal cord reflexes intact |
brain stem/hypothalamic function intact to maintain life
spinal reflexes/cranial nerves intact also: breathing, bowels, urine intact |
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list regulating factors of cerebral circulation
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C02- more sensitive
increase C02 -> increase H+ -> increase Blood flow 02 decrease 02 -> increase in blood flow |
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T/F
Ischemic stroke occurs due a blockage of the venous system |
F
arterial system |
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list risk factors for ischemic stroke
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age
men african american polycythemia, sickle cell, valvular HT disease, fibrillation alcohol cocain Hi BP/Cholesterol cigarette diabetes mellitis |
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list types of ischemic stroke
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TIA
thrombic cardiogenic |
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Which is not a type of ischemic stroke
a) TIA b) Thrombic stroke c) Hemmorhagic stroke d) Cardiogenic Stroke |
Hemmorhagic Stroke
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mechanism of ischemic stroke
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cerebrovascular obstruction by thrombosis or emboli
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cardiogenic stroke most frequently affects
a) Anterior cerebral A b) Mid cerebral A c) Post cerebral A d) Basilar A |
Mid cerebral A - therefore affects the temporal lobe
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Cause of Cardiogenic Stroke
a) Atherosclerotic Ht b) Atherosclerotic BVs c) Aneurysm d) none of the above |
Atherosclerotic HT/thrombus
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cause of thrombic stroke
a) Thrombus from Ht b) Atherosclerotic BVs c) Aneurysm d) none of the above |
Atherosclerotic BVs usually at bifurcation of common carotid/origin of basilar A
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Stroke that comes on suddenly and has detrimental effects
a) TIA b) Thrombic c) Cardiogenic d) Hemmorhoragic |
Cardiogenic
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predisposing factors of hemorrhagic stroke
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Hypertension***
aneurysm trauma arteriovenous malformation erosion of vssl by tumor coagulopathies vasculitis drugs |
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hemorrhagic stroke can cause _____ motor weakness/paralysis
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contralateral
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Longterm disability of hemorrhagic strok
a) motor deficits b) aphasia c) hemiattention d) dysarthria |
ALL:
motor deficits (contralateral) language deficits (aphasia, dysarthria, denial, hemiattention) |
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list type of skull fractures
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simple/linear
comminuted- many pieces depressed- Basilar- CSF leaks from nose |
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Not a secondary brain injury
a) hypoxia b) infection c) hemorrhage d) hematoma |
hemorrhage = primary
primary= concussion, laceration, hemorrhage, contusion secondary= hypoxia, ischemia, edema, hematoma, infection |
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types of brain hematoma
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epidural
subdural intercerebral |
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causes ipsilateral pupil dilation and contralateral hemiparesis
a) epidural hematoma b) subdural hematoma c) hemorrhagic stroke d) ischemic stroke |
epidural hematoma- due to head trauma/fractured skull
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most affected by epidural hematoma
a) internal carotid A b) mid meningeal A c) subarachnoid space d lateral ventricles |
mid meningeal A
-> rapid compression of the brain |
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T/F
subdural hematoma develops faster than epidural hematoma |
F
subdural is slower than epidural |
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brief period of unconsiousness- when consciousness is regained it is rapidly lost again
a) epidural hematoma b) subdural hematoma c) hemorrhagic stroke d) ischemic stroke |
epidural hematoma
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improvement in level of consciousness and neurologic symptoms followed by deterioration
a) acute subdural hematoma b) subacute subdural hematoma c) epidural hematoma d) ischemic stroke |
subacute subdural hematoma (w/in 2-10days)
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bleeding from brain tissue
) epidural hematoma b) subdural hematoma c) intercerebral hematoma d) all |
intercerebral hematoma- usually arterial origin
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list possible modes of entry for a brain infection
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direct wound/fracture
blood stream/any other infxn surgical contamination lumbar puncture |
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infection of pia, arachnoid, and subarachnoid space
a) Encephalitis b) Meningtitis c) Intracerebral Hematoma d) none |
meningitis
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describe the pathogenesis of meningtitis
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infection disrupts BBBarrier
-> extravasation of plasma and albumin into CSF/Brain tissue -> edema, compression, irritation |
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Not a manifestation of meningitis
a) Fever b) HA c) + Brudzinski d) + Kernig |
ALL are manifestations of Meningitis
also: photophobia, chills, NV, petechiae, rash, altered consciousness, cloudy/purulent CSF |
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most common cause of encephalitis
a) MMR b) Bacteria c) Virus d) All |
Virus
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most common cause of meningitis
a) Virus b) Bacteria c) Fungus d) all |
Bacteria
Neisseria Meningitidis haemophilus influenza S.Pneumoniae E.Coli |
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pathogenesis of encephalaitis
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local hemorrhage/necrosis
-> degeneration of Nerve cells inflammation -> edema Increase ICP |
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Which is not an intraaxial tumor of the CNS?
a) astrocytoma b) ependymoma c) meningeal d) oligodendroglioma |
meningeal tumor- usually benign
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not part of the pathogenesis of a brain tumor
a) increase ICP b) edema c) dilation of ventricles d) brain atrophy |
ALL are part of pathogenesis
compression-> Increase ICP/herniation infiltration- malignant grow fast disturbance of blood flow edema-> increase ICP obstrxn of CSF -> dilate ventricles -> brain atrophy |
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list manifestations of a brain tumor
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HA- general/1 sided, worse in am or w straining/cough/laugh/etc
vomit visual defect/papilledema personality/mental changes focal neurologic signs seizure |
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all are diagnostics of a brain tumor except
a) physical exam b) urinalysis c) angiography d) all are diagnostics |
urinalysis
diagnostics: physical exam CT, MRI, Xray angiogram |
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T/F
Laughing can increase pain of a HA due to brain tumor |
T
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list the possibilities that can cause metabolic seizure
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Electrolyte imbalance (lo Ca++, dehydration)
lo Blood Sugar lo O2 pH imbalance (out of 7.34-7.45) meningitis/encephalitis toxemia gravida- preg women xs urea in blood (KD failure) |
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T/F
xs Ca++ levels can cause metabolic seizure |
lo ca++ (also dehydration can cause electrolyte imbalance)
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Preg woman in her 2nd trimester is experiencing HA, Hi BP, and Albumin in the urine, and is at Hi risk of
a) gestational diabetes b) hemorrhagic stroke c) toxemia gravida d) none |
toxemia gravida -> seizure
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T/F
seizure is a disease of the CNS |
F
SYMPTOM of a disease of the CNS |
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NT imbalance that can cause seizure
a) xs ACh, xu GABA b) xu ACTH xu GABA c) xs GABA, xu ACh d) xs ACTH, xsGnRh |
xs ACh, xu GABA
ACh- stim brain function GABA- depress brain function |
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idiopathic seizure
a) primary b) secondary c) metabolic d) none |
primary
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secondary seizure
a) traumatic b) febrile c) metabolic d) all |
ALL
secondary = symptomatic seizure primary= no identifiable cause |
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not a mechanism of seizure
a) tumor alters neuron excitability b) change in cell membrane permeability c) increase inhibitory activity of thalamic neurons d) all are mechanisms |
DECREASE inhibitory activity of cortical or thalamic neuron activity
mechanisms of seizure -change cell permeability -decrease inhibition -altered neuron excitability/structural changes -NT imbalance -lo seizure threshold |
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seizure w/o loss of consciousness
a) absence seizure b) generalized seizure c) simple partial d) complex partial |
simple partial- specific portion of brain affected - > sudden weakness/numbness
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T/F
Complex partial seizure may be preceded by an aura |
F
simple partial |
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correct statement about complex partial seizure
a) may pass unnoticed b) no loss of consciousness b) vague warning sign c) begins localized but spreads |
begins in localized portion of brain and spreads
- accompanied by loss of conscious - automatism (bladder, bowels) -postictal confusion/hallucination/illunsion simple partial = seizure w local contraction only |
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correct statement about complex partial seizure
a) impaired arousal up to 30 min b) automatism c) preceded by aura d) involves both hemispheres |
automatism of bladder/bowels
complex partial -loss of conscious -automatism -postictal confusion |
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tonic phase
a) apnea b) cyanosis c) extension of extremities d) loss of consciousness |
ALL
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clonic phase
a) apnea b) cyanosis c) incontinence d) loss of consciousness |
incontinence of urine/bowel
also- bilateral rhythmic contraction/relaxation of extremities |
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T/F
status epilepticus can be a life threatening condition |
true
apnea during tonic phases -> no o2 |
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postictal conditions of a Grand Mal seizure
a) confusion b) hallucination c) unconsciousness d) none- seizure may pass unnoticed |
unconscious
complex partial = confusion/halluncination petite mal/absence- may pass unnoticed |
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seizure w vague warning signs
a) simple partial b) tonic-clonic c) absence d) all |
tonic-clonic
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pathophysiology of Alzheimer
a) neurofibrillary tangles b) increase choline acetyltransferase c) occipital atrophy d) none |
neurofibrillary tangles
dementia pathophys -cortical atrophy- temporal/frontal -neurofibrillary tangles - decrease choline acetyltransferase/ACh |
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which lobe(s) experience atrophy and loss of neurons with alzheimer
a) frontal b) occipital c) temporal d) all |
frontal
temporal |
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list manifestations of alzheimer
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short term memory loss
lack spontaneity disorientation impaired cognition, abstract thinking inability to perform daily activites indifference to food inability to communicate seizure |
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T/F
CT scan can confirm diagnosis of alzheimer |
F
biopsy needed to confirm |
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hypertension is most closely related to
a) Wernicke Korsakoff synd b) Alzheimer c) Multi-infarct dementia d) seizure |
multi- infarct
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cause of wenicke korsakoff synd
a) hypertension b) vit xu c) alcoholism d) genetic predisposition |
alcoholism
vit- B1 xu |
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xu of _______ is linked to wernicke korsakoff syndrome
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B1 xu
related to alcoholism |
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manifestions of wernicke korsakoff syndrome
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impaired recent memory
confabulation peripheral neuropathy unsteady gait inability to learn inability to deal w abstraction |
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confabulation is a sign of
a) alzheimer b) multi-infarct dementia c) wernicke korsakoff syndrome d) absence seizure |
wernicke korsakoff syndrome
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